domingo, 23 de julio de 2017

Cost-effectiveness of population based BRCA testing with varying Ashkenazi Jewish ancestry. - PubMed - NCBI

Cost-effectiveness of population based BRCA testing with varying Ashkenazi Jewish ancestry. - PubMed - NCBI



 2017 Jul 6. pii: S0002-9378(17)30842-6. doi: 10.1016/j.ajog.2017.06.038. [Epub ahead of print]

Cost-effectiveness of population based BRCA testing with varying Ashkenazi Jewish ancestry.

Abstract

BACKGROUND:

Population-based BRCA1/BRCA2 testing has been found to be cost-effective compared with family history-based testing in Ashkenazi-Jewish women were >30 years old with 4 Ashkenazi-Jewish grandparents. However, individuals may have 1, 2, or 3 Ashkenazi-Jewish grandparents, and cost-effectiveness data are lacking at these lower BRCA prevalence estimates. We present an updated cost-effectiveness analysis of population BRCA1/BRCA2 testing for women with 1, 2, and 3 Ashkenazi-Jewish grandparents.

METHODS:

Lifetime costs and effects of population and family history-based testing were compared with the use of a decision analysis model: 56% BRCA carriers are missed by family history criteria alone. Analyses were conducted for United Kingdom and United States populations.

STUDY DESIGN:

Model parameters were obtained from the Genetic Cancer Prediction through Population Screening trial and published literature. Model parameters and BRCA population prevalence for individuals with 3, 2, or 1 Ashkenazi-Jewish grandparent were adjusted for the relative frequency of BRCA mutations in the Ashkenazi-Jewish and general populations. Incremental cost-effectiveness ratios were calculated for all Ashkenazi-Jewish grandparent scenarios. Costs, along with outcomes, were discounted at 3.5%. The time horizon of the analysis is "life-time," and perspective is "payer." Probabilistic sensitivity analysis evaluated model uncertainty.

RESULTS:

Population testing for BRCA mutations is cost-saving in Ashkenazi-Jewish women with 2, 3, or 4 grandparents (22-33 days life-gained) in the United Kingdom and 1, 2, 3, or 4 grandparents (12-26 days life-gained) in the United States populations, respectively. It is also extremely cost-effective in women in the United Kingdom with just 1 Ashkenazi-Jewish grandparent with an incremental cost-effectiveness ratio of £863 per quality-adjusted life-years and 15 days life gained. Results show that population-testing remains cost-effective at the £20,000-30000 per quality-adjusted life-years and $100,000 per quality-adjusted life-years willingness-to-pay thresholds for all 4 Ashkenazi-Jewish grandparent scenarios, with ≥95% simulations found to be cost-effective on probabilistic sensitivity analysis. Population-testing remains cost-effective in the absence of reduction in breast cancer risk from oophorectomy and at lower risk-reducing mastectomy (13%) per risk-reducing salpingo-oophorectomy (20%) rates.

CONCLUSION:

Population testing for BRCA mutations with varying levels of Ashkenazi-Jewish ancestry is cost-effective in the United Kingdom and the United States. These results support population testing in Ashkenazi-Jewish women with 1-4 Ashkenazi-Jewish grandparent ancestry.

KEYWORDS:

Ashkenazi Jewish; BRCA; ancestry; cost-effectiveness; population testing

PMID:
 
28690137
 
DOI:
 
10.1016/j.ajog.2017.06.038

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